Are You Your Illness?

One of the things I have noticed in my decades of working with chronically ill people is that they learn to identify quite closely with their illness. They have to; it’s a survival strategy. The easiest way to adapt to pain or illness is to learn its patterns -- when it strikes, when it sleeps, what will provoke it, what will mollify it.

Psychologically, living with chronic illness or pain is like living with someone who is abusive, and from whom you have no power to escape. Eventually, you come to identify with your abuser, and make their patterns your own. This disempowerment of the self, the loss of the ability to see yourself outside of your disease, makes it far easier to live with it, yet at the same time makes it more difficult to improve.

The person who identifies with their disease is perhaps the most dangerous and difficult to help manifestion of chronic illness that I have seen, and it can take many forms. I’ve had beautiful women in tears in my office over the belief that no other would accept them as a partner because of their chronic joint pain, and I frequently see posts on social media from people whose entire public presence is built around coping with their disability. Once you have identified yourself as “I have X” (X being a diagnosis, like MS, fibromyalgia, sciatica, irritable bowel disease), separating self from disease becomes a monumental task.

Part of the problem is as a result of how we look at disease in this society. We turn health issues which are basically dysfunctional processes (an overgrowth of cells, excess deposition of fatty tissue, production of inflammatory cytokines), into a static thing: “I have IBS,” we say, or “I have arthritis.”

Once you have converted something from a process into a thing, you have made it much more difficult to change. A process is the B train on the Green Line; it can go fast or slow, make stops, let riders off and on. A thing is a rock; it does not move. It can be changed by the erosion of water and ice, but it takes eons and lifetimes will end before any discernable difference is made. Processes are malleable to time and space and changes of input. On the other hand, things don’t change, without application of saw and hammer and destructive acid.

The second part of the problem becomes how we describe ourselves. Instead of a person with high inflammatory potential and impeded antioxidant processsing, we say “I have arthritis.” Rather than being a person who reacts strongly to certain foods which influence neurotransmitter production, we admit that “I have depression.”

So there we have it. We have a thing which we cannot change, which is only sufferable by controlling our behavior in the most intrusive ways possible. You might as well proclaim “I AM HEART DISEASE.” Because that, in your heart of hearts, is what you’ve been taught to believe.

This self-identity can become so strong that I have, many times, had patients abruptly abandon successful care because it was taking away a part of their selves that they had come to accept as necessary and needed. I would call them on the phone, ask them, “What is wrong?” They would reply, “It was working so well, and then I felt so bad!”

This was my failure, because I failed to prepare my patients for what they could become in the absence of disease. They could become more, not less.

Over time, I have developed a method of helping patients to realize that which they can be, without illness, without pain, and without all of the benefits they may see themselves as getting as a result of their illness.

I call it Contemplation of You As You May Be.

Step 1: Sit somewhere quiet, where you won’t be disturbed for 10 to 15 minutes. Close your eyes, and form a mental image of yourself. See yourself, as your disease affects you, in stillness and movement, in shape and color, in smell and sound. Take a minute or two, and completely build this picture of yourself in your mind. Feel and explore the effects of your disease or your pain on your body.

Step 2: Take a piece of paper, and write down all of the attributes of your illness on your body. There will be different groups of sensations: There will be the appearance -- red, pale, swollen, scaly. There will be the sensations -- burning, achy, itchy. There will be the mental -- fatigue, forgetful, hyperactive. Then there will be the emotional -- sad, mirthful, confused, scared.

There will be more than you can think of, and the first time you do this exercise, it is best not to overwhelm yourself with too many attributes. Start with the obvious ones, that’s good enough for this time.

Step 3: Having written down all of those attributes, close your eyes again, and re-imagine the mental image of yourself that you developed in step one. Then, one by one, start removing the attributes of your illness. Start with the physical ones. See yourself without the swelling, without the redness. Take your time.

Once you have a strong image of yourself in your mind without the physical attributes, begin to remove the sensations -- the pain, the burning, the ache. What do you look like without those things? How does that image of yourself feel without them? Again, take your time. This may be as far as you get the first time you do it.

But if you can go further, keep removing more and more aspects of your illness, of your pain. Take away the sadness, take away the fatigue. In your mind’s eye, what do you look like? How do you feel? How does your voice sound? What is it like to move?

Once you have removed all of the attributes of your illness, what will remain in your minds eye is you. Your without the disease. You without the pain. You without that which has forced you to be something that you are not for so long. Be prepared; your mind will keep wanting to return you to the first image. Keep yourself fixed on the self without disease.

Know that this person, this aspect of you is alive and well, and strong. Every day, do this exercise, until finding the healthy you is a trivial matter. And as that you becomes stronger and more real, the you defined by your disease becomes weaker and weaker. Eventually, you will have divorced yourself so thoroughly from the process of your illness that your therapy -- whether it is chiropractic, or acupuncture, or exercise or diet, or all of the above -- begins to take hold. You are replacing sick belief with healthy belief.

And at some point, when you look at your reflection, you’ll realize that the you in the mirror has become the you in your mind.

7 Ways to Make This Year Better

Over the past couple of weeks, I've been talking to patients and friends about how the past year went for them. Almost without exception, I have heard how tough a year it has been, and not surprisingly; the economy is anemic, the natural world is in increasing disarray, the presidential race has illuminated a vast and perhaps unbridgeable cultural rift in our country, and the media has managed to scare the bejeezus out of everybody with terrorist ghost stories. For a lot of people, it's not a pretty world out there, and the future isn't terribly bright. But here's the secret. You can change things. Not just internally, though that is part of the process. But your will is part of what makes the world. Collectively, mankind creates the reality we live in, not only through shared values and beliefs, but also through our intent. We can create a bountiful, beautiful world, or we can create one marred by anger, fear and want. Each individual contributes to the collective reality, some to a greater degree than others, simply because they understand how to exert their will in a way that creates a large impact. Most of us, frankly, do not have that strength of intent. But we all have the ability to alter the environment immediately around us, using the raw material of the collective gestalt.

There are seven concrete acts that you can do that will change the world around you. Do these consistently, and watch the results.

Meditate

Meditation is a sure-fire way of harnessing the wild and often wasted power that exists within all of us. In the past two years, there has been a tremendous amount of research on meditation and the changes it creates, and it is the most powerful behaviour modification tool that exists. Even within a few weeks of beginning a daily meditation practice, beneficial neurological changes begin to appear. After a year or more, these changes become quite profound.

Even better, there are endless ways to meditate. Every religion in existence has some form of meditation, and engaging your spiritual side can amplify the results of your meditative practice. If you are atheist or do not adhere to any specific metaphysical tradition, mindfulness meditation has positive, powerful results.

The down side, if there is one, is that it needs to be practiced virtually every day. Once you've instilled it as a habit, this won't seem so daunting.

Exercise

Exercise is the pill for almost every ill. There are few conditions that exercise doesn't improve, and there is nobody that can achieve true health without it. And there are no excuses for not exercising. Over the years, I've gotten patients with every chronic disease under the sun to exercise, and all of them have improved from it.

You don't need a gym membership, either. A terrific cardio workout is no further away than the street out your front door. Want to lift weights? Do a bodyweight routine that uses leverage against gravity to build muscle. No time? No way. Get off Facebook.

Exercise also creates neurological as well as physiological changes that are beneficial for meeting the challenges that life throws at us. I, for one, appreciate the feeling of power and strength in my body when I am about to undertake something arduous, whether it is a long, busy day at work or a difficult meeting. My outer strength feeds my inner strength, and if you want to be powerful in this world, the power starts in your arms, legs, heart and hands.

Goalsetting: Do it right

Most people don't reach their goals, not because their goals are too difficult, but because they set the wrong kind of goals. Goals should be process-oriented, not object-oriented. For example, instead of setting a goal of, say, getting a new job this year, your goal should be talking to 10 people every week who can help you find the job you want. Instead of setting a goal of buying a new car, set a goal of putting aside $XX every week.

Process goals have the advantage of giving you frequent, positive feedback. You get that warm fuzzy feeling of looking at your growing bank account at the end of each week and realizing that you've met your goal, rather than slogging along at a goal that looks far, far away. We're designed to respond to instant, positive feedback. It's hardwired into us. Make use of that.

Additionally, process goals are more flexible than object goals. If, somewhere along the way, you decide you would much rather get that awesome commuting bike rather than a new car (a very wise decision, I might add), you don't have to change your goals at all.

Process goals will get you where you want to go, even if the end result is hidden in the far-off mists.

Time management

Look, I'm not going to mince words here. You're going to die, sooner rather than later, and you really don't have a day to waste, except for those days you choose to waste. But make time wasting a conscious choice, not a default behaviour,

Some spiritual traditions (I'm looking at you, Zen) encourage you to ignore the past and the future, and concentrate only on the present as the only time that exists. That is all well and good for focusing your attention on important matters, but it really puts the damper on long-term planning, which is not a good thing. The argument goes that if you take care of today, tomorrow will take care of itself, but that's not always true. Our environment changes constantly, and those who are not looking at the changes coming their way are the ones who will be injured by the surprise of their arrival.

Here's the thing: Buy a 50-cent notebook, steal one of the free pens from my office, and write down everything that you need or want to do. Don't worry about time, date, or priority. Just write it down, and make sure to cross them off when you've finished a task (that warm fuzzy feeling again).  You'll be surprised at how much that you thought you couldn't get done that you are suddenly accomplishing.

Also, keep the notebooks. They, as much as a daily journal, will give you a point of reflection of your life over the course of the years.

Keep it clean

Energy (and that, after all, is what we're talking about, the accumulation, control, and direction of energy) is attenuated by chaos and strengthened by order. If you're one of those people who says "Oh, my (desk, room, office) is messy, but I still know where everything is," give it up. Give it up right now. I used to be one of you, and what I sadly discovered that all the tightly focused concentration and intent and willpower would get dissipated into a steamy mess when it hit the clutter of my desk.

You want your willpower to do something for you? Don't make it march through a swamp to get to where it can do you some good.

In fact, write "clean it up" as the first entry in your new 50 cent time manager. And when you finish the first page, write it on the top of the next. And the next...

Seek the wisdom of others

Face it, you don't know everything, even if you, like I, think you do. Find mentors to help you walk your chosen paths. Find friends who will feed you when your pack is getting empty. Find assistants who are really, really good at the things you do poorly, and treat them like the gods and goddesses they are.

I often say that I am grateful to my patients, because they have taught me most of what I know as a doctor. And I know, it sounds like some cheesy marketing pablum, but it's true, dammit. I cannot tell you the number of times I have walked in the exam room to greet a new patient, and to their surprise, rather easily fixed their problem. But that's only because I had a patient last week that had the same problem, wasn't responding to the normal approach, and kept me up nights thinking about what I wasn't doing to get them better.

So, invite others into the reality you are creating and, to the extent that they are willing and able, allow them to help you create your world with you.

Wash, rinse, repeat

The common thread with everything I've said is that you can't do it once. You've got to do it frequently, often daily. Which initially sounds like a huge grind.

But the fact of the matter is, it only takes six weeks to create any new habit, good or bad. How long have you been practicing the habit of eating Doritos and watching sitcoms? Years, right? So take these six activities, do them for six weeks, and then email me and let me know what happened.

I'd say good luck, but you won't need it. Follow these guidelines, and you'll be making your own luck.